Long before patient-centered medical homes or accountable care organizations were buzzwords, Salt Lake City–based Intermountain Healthcare was looking at all of the points of care that could improve the health of patients in its system. It did not take long to identify mental health as a problem.

All too often a patient would come to one of Intermountain's 185 primary care clinics with multiple comorbidities that were exacerbated by mental health issues such as depression or dementia. So the primary care physician would refer the patient to a mental health specialist, but the next available appointment could be weeks away.

"The other problem with that is the doctors would send them and then the patients would fall into a black hole. The doctors would never hear anything back. There was no linkage," says Brenda Reiss-Brennan, PhD, APRN, director of mental health integration for Intermountain Healthcare. "So what we did, basically, is said mental health is not just provided by a mental health provider. There's a whole spectrum of mental health issues and concerns that could be addressed by the whole team."

Shifting the underlying view of mental health away from being a specialty referral to a routine medical condition that could be treated by the primary care team necessitated new roles for some, and additional expertise for the primary care clinic. "It became more of a consult, and everybody on the team did their part," Reiss-Brennan says.

A first step was to shift primary care physicians into taking a more holistic view of mental health, essentially empowering them with tools to identify patients who need mental health treatment, and enabling the PCP to provide that treatment for certain more common conditions, including mild to moderate depression.